Healthcare Provider Details

I. General information

NPI: 1023385440
Provider Name (Legal Business Name): MERIDIAN RADIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20283 STATE ROAD 7 SUITE 400
BOCA RATON FL
33498-6901
US

IV. Provider business mailing address

20283 STATE ROAD 7 SUITE 400
BOCA RATON FL
33498-6901
US

V. Phone/Fax

Practice location:
  • Phone: 561-620-7441
  • Fax:
Mailing address:
  • Phone: 561-620-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberH7715
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME0031479
License Number StateFL

VIII. Authorized Official

Name: TAMMY CARPENTER
Title or Position: INSURANCE MANAGER
Credential:
Phone: 561-620-7441